Routine Cardiac MRI: A Comprehensive, Systematic Framework for Clinical Interpretation-Podcast скачать в хорошем качестве

Routine Cardiac MRI: A Comprehensive, Systematic Framework for Clinical Interpretation-Podcast

Routine Cardiac MRI: A Comprehensive, Systematic Framework for Clinical Interpretation The presentation Routine Cardiac MRI: Systematic Approach to Interpretation provides a structured, clinically oriented roadmap for the comprehensive evaluation of cardiovascular magnetic resonance (CMR) studies, emphasizing reproducibility, anatomic precision, functional rigor, and advanced tissue characterization. Developed as an educational exhibit for the RSNA 2022 Annual Meeting, it reflects contemporary best practices in CMR interpretation. This framework is organized around four foundational pillars of CMR assessment: 1. Anatomic Assessment The presentation begins with recognition of essential cine and black-blood sequences (e.g., SSFP, double/triple inversion recovery) and proper identification of standard cardiac planes (2-chamber, 3-chamber, 4-chamber, and short-axis stacks). Emphasis is placed on: Chamber size quantification (LVEDVI, RVEDVI) Wall thickness and morphology (including HCM patterns) Right ventricular landmarks (moderator band, crista supraventricularis) Atrial dimensions and pitfalls (e.g., crista terminalis, coumadin ridge) LVOT evaluation and septal configuration Pericardial thickness (less than 3–4 mm) and enhancement patterns 17-segment LV model aligned with echocardiographic nomenclature The presentation reinforces structured evaluation using indexed volumetrics and standardized segmentation, improving diagnostic clarity and interdisciplinary communication. 2. Functional Assessment Ventricular performance is quantified via Simpson’s method on short-axis cine stacks: Stroke volume (SV = EDV − ESV); Ejection fraction (EF); Cardiac output (CO = HR × SV). Wall motion is categorized into hyperkinesis, hypokinesis, akinesis, and dyskinesis, with clinical correlations (e.g., Takotsubo cardiomyopathy, ischemic infarction, ARVC). Additional evaluation includes: Interatrial septal integrity and mobility (septal aneurysm, PFO, ASD) Interventricular septal motion (septal bounce, septal flash, ventricular interdependence) Myocardial tagging (SPAMM/CSPAMM) for strain and torsion analysis 3. Tissue Characterization A major strength of CMR lies in its multiparametric tissue assessment: T2-weighted STIR imaging for edema (myocardial-to-skeletal muscle ratio greater than 2 suggests inflammation); Late gadolinium enhancement (LGE) using IR or PSIR sequences, distinguishing ischemic patterns (subendocardial/transmural) and nonischemic patterns (midmyocardial, epicardial, diffuse). Further assessment includes: Scar quantification via semiautomated pixel analysis and polar mapping Parametric mapping: Native T1 (approximately 900–1100 ms normal range) T2 (approximately 50–60 ms normal range) Extracellular volume (ECV 28–32%) T2* (less than 20 ms suggests iron overload risk) Clinical case examples illustrate myocarditis, ischemic cardiomyopathy, and amyloidosis, demonstrating integration of edema imaging, LGE distribution, and mapping abnormalities. 4. Hemodynamic Assessment Advanced flow interrogation includes: First-pass myocardial perfusion (rest/stress) Recognition of dark-rim artifact versus true perfusion defects Phase-contrast imaging with velocity encoding (VENC) Quantification of forward/retrograde flow Bernoulli-derived pressure gradients (4 × velocity²) LVOT obstruction assessment (AO/LVOT ratio less than 0.45 predictive) Indirect quantification of valvular regurgitation: Mitral regurgitation = LVSV − FFAO Tricuspid regurgitation = RVSV − FFPA The presentation highlights practical considerations such as aliasing correction and optimal VENC selection. Clinical Impact This systematic methodology enhances: Diagnostic confidence; Interobserver consistency; Quantitative reproducibility; Pathophysiologic insight. By integrating anatomy, function, tissue biology, and hemodynamics within a unified interpretive model, the framework aligns with contemporary SCMR recommendations and reinforces CMR’s role as a comprehensive, noninvasive gold standard in cardiomyopathy and structural heart disease evaluation. APA Citation (7th Edition) Muneeb, A., Betancourt-Cuellar, S., & Palacio, D. M. (2022). Routine cardiac MRI: Systematic approach to interpretation. RSNA 2022 Annual Meeting Educational Exhibit. Hashtags #CardiacMRI #Radiology #CMR #MedicalEducation #Cardiology #ImagingScience #RSNA #LGE #RadiologyResident #AdvancedImaging #CardiovascularImaging #RadiologyEducation #MyocardialTissueCharacterization #T1Mapping #Cardiomyopathy #CardiacRadiology © 2025 AI Chavelle™ by Jeffrey Chen / SmartRad AI. All rights reserved.